Local-Regional Control in in Breast Cancer Patients with a Presumed Genetic Predisposition

Summary:Breast cancers associated with a genetic predisposition (e.g., BRCA-1 & BRCA-2 mutations) may behave more aggressively than sporadically occurring tumors. In particular, they tend to present at higher grades, lack hormone receptors, and have mutations of other genes such as p53. One might then question whether patients carrying these mutations could be at an increased risk of loco-regional recurrence with breast conserving therapy (BCT).

Methods: Because of the unwieldy cost and effort to identify the small percentage (<10%) of patients at risk, a diagnosis of bilateral breast cancer with a positive family history was used as a surrogate for germline mutations. These patients were assessed for loco-regional recurrence rates with BCT.

Results:

58 such patients were treated for stage 0-III breast cancer at the institution from 1959-1998. BCT was used in 55 cases; the remainder received mastectomy.

Median follow-up was 68 months

The 5 and 10 year actuarial rates of loco-regional control were 86% and 76% in all BCT patients.

Nine of these patients did not receive radiation therapy, and this was the only predictor of loco-regional failure (p=0.009).

Clinical/Scientific Implications:

There does not appear to be an increased risk of loco-regional failure in patients with a genetic predisposition to breast cancer.

These data confirm findings from other institutions, including Harvard, Yale, and the University of Pennsylvania.

While this study is reassuring, the possibility of late failure cannot yet be excluded.